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Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression

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  • Adams, A.
  • Vail, L.
  • Buckingham, C.D.
  • Kidd, J.
  • Weich, S.
  • Roter, D.

Abstract

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients.

Suggested Citation

  • Adams, A. & Vail, L. & Buckingham, C.D. & Kidd, J. & Weich, S. & Roter, D., 2014. "Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression," Social Science & Medicine, Elsevier, vol. 116(C), pages 161-168.
    • Handle: RePEc:eee:socmed:v:116:y:2014:i:c:p:161-168
    DOI: 10.1016/j.socscimed.2014.07.004
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    References listed on IDEAS

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    1. van Ryn, Michelle & Burke, Jane, 2000. "The effect of patient race and socio-economic status on physicians' perceptions of patients," Social Science & Medicine, Elsevier, vol. 50(6), pages 813-828, March.
    2. Riolo, S.A. & Nguyen, T.A. & Greden, J.F. & King, C.A., 2005. "Prevalence of depression by race/ethnicity: Findings from the national health and nutrition examination survey III," American Journal of Public Health, American Public Health Association, vol. 95(6), pages 998-1000.
    3. Mclean, Carl & Campbell, Catherine & Cornish, Flora, 2003. "African-Caribbean interactions with mental health services in the UK: experiences and expectations of exclusion as (re)productive of health inequalities," Social Science & Medicine, Elsevier, vol. 56(3), pages 657-669, February.
    4. Lutfey, Karen E. & Link, Carol L. & Grant, Richard W. & Marceau, Lisa D. & McKinlay, John B., 2009. "Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes," Health Policy, Elsevier, vol. 89(3), pages 279-287, March.
    5. Dinwiddie, Gniesha Y. & Gaskin, Darrell J. & Chan, Kitty S. & Norrington, Janette & McCleary, Rachel, 2013. "Residential segregation, geographic proximity and type of services used: Evidence for racial/ethnic disparities in mental health," Social Science & Medicine, Elsevier, vol. 80(C), pages 67-75.
    6. Cooper, L.A. & Roter, D.L. & Carson, K.A. & Beach, M.C. & Sabin, J.A. & Greenwald, A.G. & Inui, T.S., 2012. "The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care," American Journal of Public Health, American Public Health Association, vol. 102(5), pages 979-987.
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